Website & Online Forms Privacy Notice
Effective October 13, 2026
Dabney Behavioral Health (“DBHHC,” “we,” “us”) respects your privacy. This notice explains how we handle information you share through our website and our online forms, including the Quick Referral and New Patient Intake forms. It supplements our Notice of Privacy Practices, which explains your full rights under HIPAA and is provided to every patient at intake and on request.
If this is an emergency
Our online forms are not monitored around the clock and are not for emergencies. If you or someone else is in danger, call 911 or 988 (Suicide & Crisis Lifeline). For a child or teen in crisis in Illinois, call the CARES line at 1-800-345-9049.
What we collect
- Referral and contact information: name, date of birth, phone, email, address, language, and parent or guardian contact for minors.
- Insurance information: plan name and member or Medicaid (RIN) number, and, if you choose to upload them, pictures of your insurance card and photo ID.
- Information about the help you are looking for, and, on the intake form, health and background information you choose to share.
- Information about who referred you, such as an agency, school or hospital contact.
We ask only for what we need to contact you, check your coverage, and prepare for your first appointment.
How we use it
- To contact you about the referral and schedule services.
- To verify insurance eligibility.
- To prepare your intake and treatment planning with your clinician.
- To meet our legal, licensing and payer requirements.
We do not sell your information, and we do not use it for advertising.
How we protect it
- Our online forms are built with Microsoft Forms. Responses go directly into DBHHC's secure Microsoft 365 environment, which Microsoft provides under a HIPAA Business Associate Agreement.
- Access is limited to the staff who need it to serve you. Clinicians see only the patients assigned to them.
- Information is transmitted over encrypted connections and kept in our protected systems, including our electronic health record.
- Records are retained as required by Illinois and federal law.
Special protections
Mental health information is protected by the Illinois Mental Health and Developmental Disabilities Confidentiality Act as well as HIPAA. Substance use disorder records receive additional protection under federal law (42 CFR Part 2). We share protected information only as those laws allow, or with your written consent.
Email and text
Regular email and text messages are not fully secure. Please don't send detailed health information by regular email or text. We will contact you by phone or through our secure patient portal. If you ask us to use email or text, we will limit what we include.
Referrals made on someone else's behalf
If you are a parent, guardian, agency, school or provider referring someone, please share only what is needed and, when possible, let the person know about the referral.
Children
Referrals and intake for anyone under 18 should be completed by, or with, a parent or legal guardian, except where Illinois law allows a minor to seek care on their own.
Website visits
Like most websites, ours may record basic technical information such as your browser type and the pages you visit. We do not use this information to identify you. We do not use tracking tools on our website.
Your rights and questions
You may read our Notice of Privacy Practices or request a copy of it, ask to see or correct your records, or ask questions about your privacy at any time.
Privacy Officials: Corrina Dabney and Derrick Wilson
Dabney Behavioral Health, 845 West 69th Street, Chicago, IL 60621
Phone: (773) 651-6809 · Email: privacy@dbhhc.org
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.
We may update this notice. The effective date above shows when it was last changed.